Real-time point of care microcirculatory assessment of shock: design, rationale and application of the point of care microcirculation (POEM) tool

Naumann, David N., Mellis, Clare, Husheer, Shamus L. G., Hopkins, Philip, Bishop, Jon, Midwinter, Mark J. and Hutchings, Sam D. (2016) Real-time point of care microcirculatory assessment of shock: design, rationale and application of the point of care microcirculation (POEM) tool. Critical Care, 20 . doi:10.1186/s13054-016-1492-1


Author Naumann, David N.
Mellis, Clare
Husheer, Shamus L. G.
Hopkins, Philip
Bishop, Jon
Midwinter, Mark J.
Hutchings, Sam D.
Title Real-time point of care microcirculatory assessment of shock: design, rationale and application of the point of care microcirculation (POEM) tool
Journal name Critical Care   Check publisher's open access policy
ISSN 1466-609X
1364-8535
Publication date 2016-09-30
Sub-type Article (original research)
DOI 10.1186/s13054-016-1492-1
Open Access Status DOI
Volume 20
Total pages 9
Place of publication London, United Kingdom
Publisher BioMed Central
Language eng
Formatted abstract
Background: Despite over a decade of research and technological advances, sublingual microcirculatory monitoring has not yet reached clinical utility. Offline analysis is time consuming and occurs away from the patient. A system to assess the microcirculation at the point of care is desirable. We present a novel 5-point grading system (the point of care microcirculation (POEM) scoring system) that can be used at the point of care during non-invasive sublingual microcirculatory monitoring.

Methods: The POEM score is an ordinal scale from 1 (worst) to 5 (best), based on a composite assessment of flow and heterogeneity of four individual sublingual video-microscopy clips. Thirty-two healthcare professionals were trained in how to assign POEM scores. Following training they assigned scores to five test sequences (each consisting of four video clips). They were blinded to clinical status. Inter-user consistency and agreement were assessed using intra-class correlation coefficient (ICC) analysis. In addition, blinded expert scores for 68 video clips were compared to offline computer analysis using traditional microcirculatory parameters including total vessel density (TVD), perfused vessel density (PVD), proportion of perfused vessels (PPV), microcirculatory flow index (MFI) and microcirculatory heterogeneity index (MHI). The time taken to assign each was recorded.

Results: Participants showed good inter-rater consistency (ICC 0.83, 95 % CI 0.626, 0.976) and agreement (ICC 0.815, 95 % CI 0.602, 0.974) for assigned POEM scores. Expert scoring of videos correlated with offline values for PVD (R2 = 0.39; p < 0.05), PPV (R2 = 0.71; p < 0.001), MFI (R2 = 0.75; p < 0.001), and MHI (R2 = 0.68; p < 0.001). POEM scores took less time to assign than conventional offline computer analysis (2 minutes versus 44 minutes).

Conclusion: We present for the first time a novel 5-point ordinal scale of microcirculatory flow and heterogeneity that can be used at the point of care. It has minimal inter-user variability amongst healthcare professionals after just 1 hour of training. POEM scores take a short time to assign, and correspond well to traditional offline computer-analyzed parameters.
Keyword Circulation
Hemorrhage
Microcirculation
Point-of-care
Sepsis
Shock
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Admin Only - School of Medicine
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